Division of Clinical Pharmacology, Department of Medicine, Vanderbilt School of Medicine, Nashville, Tenn.
Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tenn.
J Allergy Clin Immunol Pract. 2013 Sep-Oct;1(5):468-73.e1-4. doi: 10.1016/j.jaip.2013.05.003. Epub 2013 Jun 21.
The incidence of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema is increased in patients with seasonal allergies.
We tested the hypothesis that patients with ACE inhibitor-associated angioedema present during months when pollen counts are increased.
Cohort analysis examined the month of presentation of ACE inhibitor-associated angioedema and pollen counts in the ambulatory and hospital setting. Patients with ACE inhibitor-associated angioedema were ascertained through (1) an observational study of patients presenting to Vanderbilt University Medical Center, (2) patients presenting to the Marshfield Clinic and participating in the Marshfield Clinic Personalized Medicine Research Project, and (3) patients enrolled in The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET). Measurements include date of presentation of ACE inhibitor-associated angioedema, population exposure to ACE inhibitor by date, and local pollen counts by date.
At Vanderbilt, the rate of angioedema was significantly associated with tree pollen months (P = .01 from χ(2) test). When separate analyses were conducted in patients with a history of seasonal allergies and patients without, the rate of ACE inhibitor-associated angioedema was increased during tree pollen months only in patients with a history of seasonal allergies (P = .002). In Marshfield, the rate of angioedema was significantly associated with ragweed pollen months (P = .025). In ONTARGET, a positive trend was observed between the ACE inhibitor-associated angioedema rate and grass season, although it was not statistically significant (P = .057).
Patients with ACE inhibitor-associated angioedema are more likely to present with this adverse drug event during months when pollen counts are increased.
血管紧张素转换酶（ACE）抑制剂相关血管性水肿的发生率在季节性过敏患者中增加。
我们检验了这样一个假设，即在花粉计数增加的月份，ACE 抑制剂相关血管性水肿的患者会出现。
通过在门诊和医院环境中分析 ACE 抑制剂相关血管性水肿的发作月份和花粉计数，进行了队列分析。通过以下方式确定 ACE 抑制剂相关血管性水肿的患者：（1）对范德比尔特大学医学中心就诊患者的观察性研究；（2）在 Marshfield 诊所就诊并参加 Marshfield 诊所个性化医学研究项目的患者；（3）参加正在进行的替米沙坦单独和与雷米普利联合的全球终点试验（ONTARGET）的患者。测量包括 ACE 抑制剂相关血管性水肿发作的日期、按日期计算的 ACE 抑制剂人群暴露量和按日期计算的当地花粉计数。
在范德比尔特，血管性水肿的发生率与树木花粉月份显著相关（卡方检验 P =.01）。当在有季节性过敏史和无季节性过敏史的患者中分别进行分析时，只有有季节性过敏史的患者在树木花粉月份 ACE 抑制剂相关血管性水肿的发生率增加（P =.002）。在 Marshfield，血管性水肿的发生率与豚草花粉月份显著相关（P =.025）。在 ONTARGET 中，虽然没有统计学意义（P =.057），但 ACE 抑制剂相关血管性水肿的发生率与草季之间存在正相关趋势。
ACE 抑制剂相关血管性水肿的患者在花粉计数增加的月份更有可能出现这种不良药物事件。
